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AbstractObjective: To cross-culturally translate and validate a Danish version of the Physical Activity Enjoyment Scale (PACES-8) for rehabilitation patients. Enjoying physical activity supports rehabilitation patients’ incentives to maintain a physically active lifestyle, and PACES-8 makes enjoyment measurable.Methods and measures: After translation/back-translation, face and content validity were examined by qualitative interviewing four physiotherapists and 12 patients. PACES-8 sum scores range from 8 (lowest) to 56 (highest). Rehabilitation patients (n = 99) responded to PACES-8. Internal consistency and construct validity were examined using explorative factor analysis (EFA), convergent validity with the WHO-5 Wellbeing index, and floor-ceiling effects.Results: PACES-8 covers hedonic and eudaimonic aspects of enjoyment, although some informants expressed that exercising should be for health, not joy. Immediately after various forms of training, respondents’ median PACES-8 score was 51.0, and WHO-5 scores indicated a moderate/high wellbeing for 87.9%. Group-based and outdoor training were more enjoyable than strength training and individual training. Internal consistency showed a Cronbach alpha value of 0.890. EFA revealed a one-factor structure, low convergent validity, and no floor/ceiling effects.Conclusion: The Danish version of PACES-8 shows promising psychometric properties for rehabilitation patients. PACES-8 provides the basis for health professionals and patients to collaborate in identifying enjoyable physical activities. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop and validate a patient-reported experience measure (PREM) to examine the patients' perspectives on the quality of outpatient physiotherapy and occupational therapy rehabilitation. Materials and methods: A systematic literature search in PubMed, Embase, Scopus, and Cinahl was conducted to identify relevant themes for the questionnaire. Fourteen studies were analyzed through a systematic text condensation to identify quality aspects in the rehabilitation from patients' perspectives. Further, based on the analysis, 13 items with answers on a five-point Likert scale were developed. Face validity and content validity were established during interviewing 14 municipality outpatients. Finally, to determine the construct validity and internal consistency, the questionnaire was distributed to 385 patients with various diagnoses. Results: The final questionnaire, Outpatients' Experience of quality in Rehabilitation (OPER), demonstrated good face and content validity and covered patients' experience of quality in municipal rehabilitation. Data from 307 respondents established construct validity and high internal consistency and showed, in general, a positive experience of outpatient rehabilitation. Conclusions: The OPER demonstrates satisfactory psychometric properties based on an extensive development and validation process. By assessing outpatients' experience of the rehabilitation process, OPER offers a measurement of the quality of therapists' practice of patient-centered rehabilitation. IMPLICATIONS FOR REHABILITATION: Quality in outpatient rehabilitation should be measured with patient-reported experience measures (PREMs) that encompass patients' experience of the rehabilitation process. Based on analyses of the literature and a thorough validation process, the study developed a PREM for outpatient rehabilitation: OutPatients' Experience of quality in Rehabilitation (OPER). OPER demonstrates satisfying psychometric properties in an outpatient population with various diagnoses. OPER is based on patient-centeredness in meeting with physiotherapists and occupational therapists. [ABSTRACT FROM AUTHOR]

Purpose: Post-stroke patients constitute a large group suffering from disabilities that require rehabilitation long after discharge. Quality indicators (QIs) that specify the minimum expected standard of quality in outpatient rehabilitation could contribute to the valuation of the effectiveness of rehabilitation on decision-makers, health professionals, patients, and relatives. This review aims to identify QIs focusing on physiotherapists' outpatient rehabilitation of stroke patients. Materials and methods: The databases Cinahl, Cochrane, Embase, PubMed, and Scopus were searched for publications, and the grey literature was also searched. Through a pragmatic appraisal and assessment with the modified AGREE II-QI instrument, relevant QIs were selected. Results: A total of 1129 papers were retrieved, and five papers presenting 91 QIs were included. Thirty-six QIs were considered relevant to physiotherapy in outpatient rehabilitation. The QIs cover structure, process, and outcome and concern basic mobility, spasticity, organisation and content of the training, patient-reported outcome measures, education of patients and relatives, and follow-up and goal setting. Conclusions: The study appraised 36 QIs relevant for outpatient rehabilitation of stroke survivors conducted by physiotherapists. A Delphi panel is required to develop the final set of QIs for physiotherapists and, subsequently, the development of a core set of multidisciplinary QIs. [ABSTRACT FROM AUTHOR]

BackgroundPurposeMethodsResultsConclusionRefugees from Syria face health challenges with psychosocial dimensions due to disrupted networks, uncertain life situations, and language barriers. Additionally, a sedentary lifestyle increases the risk of noncommunicable diseases, so health-promoting initiatives involving physical activities are essential.To explore physiotherapists’ clinical reasoning and collaboration with refugee families in developing group-based health-promoting physical exercising to increase participants’ wellbeing, sense of togetherness, and self-efficacy.The design was participating action research with 24 resettled refugees from Syria. Data consisted of field notes and three focus group interviews. Data gathering followed a phenomenological approach, and the four-step analysis was inspired by Giorgi.Based on clinical reasoning and collaboration with the participants and their wishes, the physiotherapists organized a physical exercise intervention integrating language learning. The physiotherapists based the intervention on social cognitive theory, focusing on the group’s and the individual’s capacity and working with the participants on exercise and organizational adaptations to the group and individual. The participants appreciated the joyful physical activities, body awareness, and a sense of togetherness. To accommodate that many suffered from musculoskeletal pain, the physiotherapists developed an intervention for therapeutic exercising that included individual assessment and pain management.The physiotherapists’ clinical reasoning in working with refugees included the cultural, linguistic, and social context rooted in a salutogenic perspective. The participants’ wellbeing and self-efficacy in adhering to exercise increased. They experienced pain relief and increased confidence in using the body. [ABSTRACT FROM AUTHOR]

Background: The increasing survival after a lung cancer diagnosis implies that patients live longer with the disease, which means that symptoms and side effects of the treatment become part of everyday life. Aim: The study explored how older adults make meaning of everyday life when undergoing treatment for their lung cancer. Material and methods: A qualitative study using semi-structured interviews was conducted with 12 older adults with lung cancer undergoing various treatments. The analysis followed Giorgi's phenomenologic five-step method. Results: The analysis revealed three partly overlapping themes: meeting the health care system, losing identity, and struggling for meaning in everyday life. The patients appreciate clear and coherent communication at the oncology clinic. They had different needs for support from organised support groups, friends, communities, or relatives to make meaning of everyday life. Conclusion: Creating meaning in everyday life is essential despite the disease and the treatments' side effects. Interpersonal relationships create meaningfulness in everyday life through a salutogenic perspective that makes everyday life comprehensible and manageable. Significance: The patients need an everyday life perspective on the disease and the side effects, which a salutogenic approach in the encounter with the health care system could support. [ABSTRACT FROM AUTHOR]

Fractures following trauma affect physical and mental health for working-age persons, and the International Classification of Functioning, Disability, and Health (ICF) can help therapists understand the fractures' impact on daily lives. To examine self-reported functioning and outcomes six months after upper and lower body fractures and compare limitations using the ICF. Data were collected from 160 patients with fractures as part of a prospective cohort study. The primary outcome measure was the Short Musculoskeletal Function Assessment questionnaire that covers all domains of the ICF. Moreover, sick leave, sense of coherence, and physical activity were reported. Six months after the injury, function had improved significantly, but patients reported problems on all domains in the ICF with few differences between the upper and lower body groups. Leisure activities caused problems for 63 (38.8%) of the patients and bothered 86 (53.8%). Problems performing work bothered 63 (39.4%) with no significant difference between the groups, although a significantly higher proportion in the upper body group had returned to work within two months (p <.001). Six months after fractures, adults reported problems on all ICF domains, especially on the participation dimension, which therapists should address in the rehabilitation process. [ABSTRACT FROM AUTHOR]

The aim of this classic grounded theory study was to develop a substantive theory explaining variations in patients' expectations of physiotherapists when contacting a clinic. The study was nested in a survey cohort study, and data constituted a single open-ended question: State what you expect the physiotherapist to help you with. Responses were obtained from patients before attending the clinic. Statements were analysed using classic grounded theory with open, selective, and theoretical coding. The authors concurrently used memos and constant comparison until theoretical saturation was achieved, categories were identified, and a theoretical model was developed. Based on 292 statements from patients primarily suffering from musculoskeletal problems, the theory grounded in data Expectations as a continuum was developed. Four typologies created the theory: (1) Doing something, so it is again possible to..., (2) Finding out what is wrong with me, (3) Relieving/getting rid of symptoms, and (4) Help to self-help. The theory Expectations as a continuum illuminates that patients' expectations range from helplessness to being competent to act and reflect the social cognitive theories health locus of control and self-efficacy. Patients' abilities for self-management are different, and physiotherapists should carefully adjust the requirements for self-management. [ABSTRACT FROM AUTHOR]

Purpose: The study investigated health-related quality of life (HRQoL) for patients with chronic conditions attending physiotherapy regularly and also examine the impact of physiotherapy on HRQoL. Methods: In this mixed methods study, 52 patients attending group physiotherapy because of various chronic conditions answered the EuroQoL five-dimensional instrument (EQ-5D-3L) questionnaire (respondents). Three focus group interviews were conducted with nine of them (participants) and analysed according to Giorgi's phenomenological method. Results: Most of the respondents reported moderate problems with mobility, usual activities, and pain/discomfort on the EQ-5D dimensions. The interviews stated that physiotherapy was important for the participants because the physiotherapist used the patient-centred approach and managed to provide individually tailored patient education and pain management. The training had an impact on health-related quality of life and made it possible for the participants to take part in social life with family and friends. Recognition of limitations from peers in the group and from the physiotherapist played an important role for their motivation and adherence to the group training. Conclusion: Health-related quality of life was affected for patients with chronic conditions. Groupbased physiotherapy with individually tailored patient education made it possible to maintain a certain level of independence in everyday activities. [ABSTRACT FROM AUTHOR]

Physical activity is important for health but injuries might affect the level of activity. The aim of this study was to evaluate change in physical activity after fracture and to determine predictors for return to a previously high/moderate level of physical activity at 6 months following injury. A cohort study was conducted that included 201 people aged 18–64 years who suffered fractures. Participants reported their level of physical activity prior to the injury and perceived change after six months (n = 164). Subgroup analysis of 95 preinjury physical active participants was performed with logistic regression analysis and odds ratio (OR). Totally, 27.4% (n = 45) returned to their previous level of physical activity and for the 95 pre-injury physically active participants it was 27.3% (n = 26). Low income OR 3.15 (95% CI 1.78–28.05), not receiving rehabilitation OR 0.09 (95% CI 0.02–0.37), and sustaining upper limb fractures compared to lower limb fractures OR 0.09 (95% CI 0.02–0.51) were positively associated with return to preinjury physical activity levels at 6 months after controlling for significant factors. Fracture affects physical activity at six months even for pre-injury active individuals. Therapists should pay attention to guiding patients to perform physical activities despite their injury. [ABSTRACT FROM AUTHOR]

To investigate how accidents leading to fracture affect sense of coherence and health-related quality of life 6 months later and the association between the two phenomena. A cohort study including 201 patients admitted to hospital with fractures was conducted. Data were based on structured interviewing a few days after admission and 6 months later. Sense of coherence was evaluated with a nine-item scale and health-related quality of life was examined with the subscales of Short Form-36 (SF-36). Follow-up comprised 164 patients (81.6%), mean age 47 years. Sense of coherence changed to be either stronger (43%) or weaker (41%) and was stable for 15.9% of the participants. Health-related quality of life changed positively after 6 months but did not reach normative values. Strong sense of coherence was significantly associated with the SF-36 subscales emotional role functioning, social functioning, vitality, and mental health. Accidents leading to fracture can be stressful life events that could influence an individual's sense of coherence to be stronger or weaker. The association between sense of coherence and health-related quality of life emphasises the importance of therapists supporting the patients' personal resources and promote a salutogenic focus. An injury may change an individual's sense of coherence to be stronger or weaker. For patients who sustain fracture, sense of coherence should be included in therapists' analysis of personal resources and support a salutogenic perspective. Health-related quality of life is especially for younger individuals affected by an accident and its consequences and need a guided and meticulous rehabilitation course. [ABSTRACT FROM AUTHOR]

Objective: Case management has since the 1970s been widely used to co-ordinate services for mental health patients. The methodology has expanded to support patients in many different types of conditions. This study is one of very few randomized trials on case management in a European setting. It examined the impact of case management on substance abuse and use of service after discharge from court-ordered institutional care. Methods: Court-ordered patients with substance abuse ( n = 36) were randomly assigned to either strengths based case management or treatment-as-usual during 6 months in aftercare. Data was collected at intake, at conclusion of intervention and at 6 month's follow-up with a follow-up rate of 94%. Results: Case management interventions were well received by the patients with no drop-out during intervention. Patients with the support of a case manager seemed to sustain abstinence in a higher degree compared with treatment-as-usual but no differences were detected in regard to use of care. A subgroup analysis showed that patients with a continuous drug abuse did have access to care from both social welfare and hospital care systems. Conclusions: Case management may be useful in order to retain abstinence in aftercare following court-ordered treatment. The social welfare and hospital care systems seem to provide care irrespective of case manager intervention. The study design, interventions and assessments instruments were well received by patients but needs to be replicated with a larger population. Clinical implications: The 100% retention in the case management support group indicates that patients were satisfied with this type of intervention and the methodology seems to be useful in order to retain abstinence. [ABSTRACT FROM AUTHOR]

The use of tele-rehabilitation (TR) is a rapidly growing area within health care with the aim of dealing with the demographics changes of a growing elderly population and increasing number of patients with chronic conditions needing rehabilitation. Results from research indicate, that TR is equally as efficient as usual care. However, there is a need for more studies of high quality on the efficacy and cost-effectiveness of TR just as the long-term effects of TR have to be determined. In addition, there is a need for qualitative studies elucidating the patients' perspective of TR.

Objectives: To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity., Design: Multicentre, multinational, randomised clinical trial with masked outcome assessment., Setting: Stroke units in Denmark, China, Poland, and Estonia., Participants: 314 patients with ischaemic stroke aged >or=40 years who were able to walk-157 (mean age 69.7 years) randomised to the intervention, 157 (mean age 69.4 years) in the control group., Interventions: Patients randomised to the intervention were instructed in a detailed training programme before discharge and at five follow-up visits during 24 months. Control patients had follow-up visits with the same frequency but without instructions in physical activity., Main Outcome Measures: Physical activity assessed with the Physical Activity Scale for the Elderly (PASE) at each visit. Secondary outcomes were clinical events., Results: The estimated mean PASE scores were 69.1 in the intervention group and 64.0 in the control group (difference 5.0 (95% confidence interval -5.8 to 15.9), P=0.36. The intervention had no significant effect on mortality, recurrent stroke, myocardial infarction, or falls and fractures., Conclusion: Repeated encouragement and verbal instruction in being physically active did not lead to a significant increase in physical activity measured by the PASE score. More intensive strategies seem to be needed to promote physical activity after ischaemic stroke., Trial Registration: Clinical Trials NCT00132483.